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N137 (scaler and curet), N135(scaler), 204SD (scaler), Columbia 13/14 (curet), gracey 11/12 (curet) and Gracey 13/14 (curet)
fundamentals of instrumentation
Stabilization = correct grasp and fulcrum |
more bends in the shank, more area specific |
instruments ADAPTATION, ANGULATION, ACTIVATION |
# indicates the specific design of the working end and the are of the dentition indicated for use |
area specific |
only adapts to certain surfaces in certain areas of the mouth |
universal |
used on any area of the mouth (both anterior and posterior) |
weight |
lighter handles enhance TACTILE SENSITIVITY and lessen fatigue related to a tighter grasp, ideally less than 15.0g |
diameter |
6.5mm- 10mm. thin handles can lead to RSI (repetitive stress injury). ergonomic instruments have 10mm diameter |
texture |
textured provide better control, increase tactile sensitivity |
shape |
straight: anterior teeth. angled complex: proximal surfaces of posterior teeth |
length |
most instruments: 35-40mm |
rigidity |
stronger: remove calculus. flexible: remove fine deposits of calculus |
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PROBING
Design, Characteristics |
calibrated in millimeter increments (NOT all probes have the same marking patterns) |
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blunt, rod-shaped working that may be circular or rectangular in cross section |
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working-end and the shank meet in defined angle that is >90 degrees |
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stainless steel, titanium or plastic |
Function |
MAIN detect periodontal pockets to determine the health status of the periodontist |
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measure clinical attachment loss |
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measure extent of recession of the gingival margin |
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measure the width of the attached gingiva |
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measure the size of intramural lesions |
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assess bleeding on probing |
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determine mucogingival relationship |
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monitoring the response of the periodontium to treatment |
Probing depth |
the distance in millimeters from the gingival margin to the base of the sulcus or periodontal pocket as measures with a probe |
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Base of sulcus is at the junctional epithelium |
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round up to nearest full millimeter |
Healthy State |
1-3 mm |
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the probe touches the tooth near the CEJ at the JE |
Disease State |
greater than 3 mm |
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probe tip touches somewhere below the CEJ |
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MIRROR
function of the mirror |
1. indirect vision |
to see tooth surfaces or intramural structures that CANNOT be seen using direct vision |
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2. retraction |
hold the pt's cheek, lip or tongue see tooth surfaces |
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3. indirect illumination |
reflect light onto a tooth surface in a dark area o the mouth |
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4. transillumination |
directing light off to the mirror surface and through the ANTERIOR TEETH (helps aid in detection of inter proximal caries) LOOKING DIRECTLY ON THE TOOTH |
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CLASSIFICATION OF INSTRUMENTS
assessment |
mirror, explorer, probes |
treatment |
scalers, hoes, chisels, files, curets (universal/area specific), powered scalers |
N137 SCALER
crowns ONLY |
Universal in design, area specific in use |
anterior ONLY (sextant 5 mostly) |
all surfaces (BEST in proximal surfaces) |
N137 CURET
BOTH crowns and roots |
Universal in design, area specific in use |
Anteriors |
ALL SURFACES |
204SD "small and dainty"
Scaler |
Crowns ONLY |
Universal |
BOTH anterior and posterior |
ALL SURFACES ( BEST in proximal premolar and anterior) |
N135
scaler |
crowns ONLY |
universal |
BOTH posterior and anterior |
ALL SURFACES (BEST in proximal of posterior) |
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Columbia 13/14
curet |
crown and roots |
universal |
BOTH posterior and anterior |
ALL surfaces |
Gracey 11/12
curet |
crowns and roots |
area specific |
posterior ONLY |
lingual, medial, buccal (everything but the distal) |
outer working edge- fattest from the handle |
Gracey 13/14
curet |
crowns and root |
area specific |
posterior ONLY |
distal surfaces ONLY |
inner edge- closest to the handle |
Gingival Pocket
Gingival enlargement and coronal migration of the gingival margin |
No loss of clinical connective tissue attachment |
Junctional epithelium has not migrated apically |
Periodontal Pocket
A gingival sulcus that has been deepened by disease; depth is greater than 3mm |
Forms from apical migration of the junctional epithelium and of periodontal fibers |
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EXPLORER
Function |
determine the health of the periodontal tissues, tooth anatomy and the texture of tooth surfaces. |
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detect by TACTILE means, the texture and character if tooth surfaces debone during and after periodontal instrumentation to assess the programs and completeness of instrumentation |
Design |
flexible metal conduct vibrations form the working end to the clinicians fingers. |
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working- end is 1 to 2 mm in length and referred to as the explorer tip |
11/12 Explorer |
side of the explorer tip is applied to the tooth surface |
Surface Assessment |
supragingival (above the gingival) subgingival (below the in the gingival margin) |
Explorer Types |
Shepard hook, straight, curved, pigtail and cowhorn, orban-type, 11/12 type |
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